Vascular Health and Risk Management
Objective: This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS).
Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established.
Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with �18 hours of sinus rhythm were selected for HRV analysis (number [N] �193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed.
Results: During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency �42 ms2 predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] �2.3; 95% confidence interval [CI] �1.4–3.8, P�0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power �8 ms2 ( HR �3.8; 95% CI �1.5–10.1; P�0.007) and troponin �0.3 ng/mL (HR �4.0; 95% CI �1.3–12.1; P�0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes.
Conclusion: HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study.
Harris, Patricia R.E.; Stein, Phyllis K.; Fung, Gordon L.; and Drew, Barbara J., "Heart Rate Variability Measured Early in Patients with Evolving Acute Coronary Syndrome and 1-year Outcomes of Rehospitalization and Mortality" (2014). Collected Faculty and Staff Scholarship. 67.
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